GPs prescribe more opioid drugs for pain in poorer areas of England

Experts say opioids prescribed for chronic pain are not the most effective form of treatment.Photograph: John Moore/Getty Images

People living in deprived areas of England are more likely to be prescribed opioid drugs for pain relief than those in wealthier parts of the country, according to research.

A study found GPs in parts of Blackpool and St Helens prescribe the highest levels of opioids in England. Five areas in north-east England and four areas in the north-west were among the top 10 highest prescribers.

There has been concern internationally about the rising use of opioid drugs, including morphine, fentanyl, oxycodone, tramadol and codeine. Prescriptions have risen and so have overdoses, particularly in the US.

Opioids tend to be prescribed for chronic lower back pain and arthritis, despite research showing the drugs are not the most effective way to treat such pain and that people tend to need higher doses over time to get the same relief.

A study last year by researchers at University College London found that the amount of opioid drugs being prescribed to patients has been steadily rising since 2010 and that the drugs are more often used in poorer areas. The lead author Luke Mordecai, a pain research fellow, called for a national database of people taking higher doses of opioids.

One of the authors, Dr Li-Chia Chen, a senior lecturer at Manchester University, suggested that the pressures on GPs in poor areas with large numbers of sick patientscould be one of the factors for high incidences of prescribing.

“Chronic pain is difficult to manage and unfortunately, because their workload pressures are so stringent, GPs have limited capacity to counsel patients with persistent pain,” she said. “This might explain why drug therapy is the main way GPs manage pain.”

But writing opioid prescriptions not only may not work but could also increase the pressure on the NHS.

“There’s no guarantee that long-term use of opioid analgesics can resolve chronic pain. Indeed the risk of opioids’ side-effects such as dependency, respiratory depression and immunosuppression may sometimes outweigh the potential benefits,” Chen said.

She called for alternatives to drugs for people with chronic pain. “Social prescribing such as meditation and acupuncture may be helpful, but little is available on the NHS,” she said.

“We also feel it is essential to integrate pain management services with an interdisciplinary team approach. Pharmacists could also play a vital role in pain management and, in our view, are an underused resource.”

Co-author Dr Roger Knaggs, associate professor in clinical pharmacy practice at the University of Nottingham, pointed out that opioids will relieve acute pain, such as that caused by an injury or surgery or cancer and they help people at the end of life. But, there are only modest benefits for many types of chronic pain, such as back pain, arthritis and nerve pain.

“We need to understand more about why opioids are prescribed more commonly in areas of greater deprivation and to ensure there is collaboration between different parts of the healthcare system to provide appropriate services and support are available for people who are prescribed opioids.”

Another co-author, Dr Teng-Chou Chen from Manchester University, said: “We suppose an average manual worker, which is common in socially deprived areas, is more likely to have musculoskeletal problems, and therefore needs opioids.

“Smoking and depression are also more prevalent in poorer areas, but whatever the causes, it’s clear that people living in more deprived areas are at a higher risk of overdose, and it is helpful for clinicians to be aware of this.”